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{{short description|Form of execution involving injection of chemicals into the bloodstream}}
{{About||the 1993 album|Lethal Injection (album
{{Globalize|article|US|date=August 2023}}
{{Use mdy dates|date=March 2016}}
[[File:Map of US lethal injection usage.svg|thumb|250px|Usage of lethal injection for the death penalty by jurisdiction in the United States in
<br />'''With the death penalty'''
{{legend|#CC6633;|Jurisdiction uses only this method (15)}}
{{legend|#FF9900;|Jurisdiction uses this method primarily but has other methods (12)}}
'''Without the death penalty'''
{{legend|#7fff00;|Jurisdiction once used this method, but no longer does (8)}}
{{legend|#0048BA;|Jurisdiction once adopted this method, but never actually used it (4)}}
{{legend|#0099CC;|Jurisdiction has never adopted or used this method (11+)}}
]]<!--Please note that other methods' pages, namely firing squad, gas chamber, and electric chair, use the same map image and caption format. If you change the image or caption, please change the others too. -->
'''Lethal injection''' is the practice of injecting one or more drugs into a person (typically a [[barbiturate]], [[Neuromuscular-blocking drug|paralytic]], and [[potassium chloride|potassium]] solution) for the express purpose of causing rapid [[death]]. The main application for this procedure is [[capital punishment]], but the term may also be applied in a broader sense to include [[euthanasia]] and other forms of [[suicide]]. The drugs cause the person to become unconscious, stops their breathing, and causes a heart [[arrhythmia]], in that order.
First developed in the [[Capital punishment in the United States|United States]], it has become a legal means of execution in [[Capital punishment in China|Mainland China]], [[Capital punishment in Thailand|Thailand]] (since 2003), [[Capital punishment in Guatemala|Guatemala]], [[Capital punishment in Taiwan|Taiwan]], the [[Capital punishment in the Maldives|Maldives]], [[Capital punishment in Nigeria|Nigeria]], and [[Capital punishment in Vietnam|Vietnam]], though Guatemala abolished the death penalty in civil cases in 2017 and has not conducted an execution since 2000 and the Maldives has never carried out an execution since its independence. Although Taiwan permits lethal injection as an execution method, no executions have been carried out in this manner;<ref>{{cite web |url=https://www.deathpenaltyworldwide.org/country-search-post.cfm?country=Taiwan |title=The Death Penalty in Taiwan |access-date=2018-01-29 |url-status=live |archive-url=https://web.archive.org/web/20171118013613/http://www.deathpenaltyworldwide.org/country-search-post.cfm?country=Taiwan |archive-date=November 18, 2017 |df=mdy-all }}</ref> the same is true for Nigeria. Lethal injection was also used in the [[Capital punishment in the Philippines|Philippines]] until the country re-abolished the death penalty in 2006.<ref>{{cite web|url=http://www.capitalpunishmentuk.org/injection.html|title=Lethal injection|website=www.capitalpunishmentuk.org|access-date=2016-07-08|url-status=live|archive-url=https://web.archive.org/web/20160303202827/http://www.capitalpunishmentuk.org/injection.html|archive-date=March 3, 2016|df=mdy-all}}</ref>
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[[Potassium]] is an [[electrolyte]], 98% of which is intracellular. The 2% remaining outside the cell has great implications for cells that generate action potentials. Doctors prescribe potassium for patients when potassium levels in the blood are insufficient, called [[hypokalemia]]. The potassium can be given orally, which is the safest route; or it can be given intravenously, in which case strict rules and hospital protocols govern the rate at which it is given.
The usual intravenous dose of 10–20 mEq per hour is given slowly since it takes time for the electrolyte to equilibrate into the cells. When used in state-sanctioned lethal injection, bolus potassium injection affects the electrical conduction of heart muscle and ultimately leads to cardiac arrest. The potassium bolus delivered for lethal injection causes a rapid onset of elevated extracellular potassium, also known as [[hyperkalemia]], causing [[depolarization]] of the resting membrane potential of the heart muscle cells, particularly impacting the heart's pacemaker cells. However, potassium's effect on membrane potential is concentration dependent and ultimately occurs in two phases. Given the reference range for serum potassium is 3.5-5.5 mEq/L, concentrations up to 8 mEq/L shorten action potential duration and the refractory period due to an allosteric effect of potassium ions on potassium channels, leading to increased conduction velocity and subsequently quicker potassium efflux which contributes to quicker repolarization and the mentioned shortening of the refractory period.<ref name=":6">{{Cite journal |last1=Weiss |first1=James N. |last2=Qu |first2=Xhilin |last3=Shivkumar |first3=Kalyanam |date=March 2017 |title=The Electrophysiology of Hypo- and Hyperkalemia |url=https://www.ahajournals.org/doi/10.1161/CIRCEP.116.004667 |journal=Circulation: Arrhythmia and Electrophysiology |volume=10 |issue=3 |doi=10.1161/CIRCEP.116.004667 |pmid=28314851 |via=PubMed}}</ref><ref>{{Citation |last=Rastegar |first=Asghar |title=Serum Potassium |date=1990 |work=Clinical Methods: The History, Physical, and Laboratory Examinations |editor-last=Walker |editor-first=H. Kenneth |url=https://www.ncbi.nlm.nih.gov/books/NBK307/ |access-date=2024-08-16 |edition=3rd |place=Boston |publisher=Butterworths |isbn=978-0-409-90077-4 |pmid=21250149 |editor2-last=Hall |editor2-first=W. Dallas |editor3-last=Hurst |editor3-first=J. Willis}}</ref> At approximately 8 mEq/L and beyond, the shortened refractory period and increased resting membrane potential diminishes the quantity of voltage-gated sodium channels ready to contribute to rapid phase 0 depolarization due to the inactivation gate requiring further repolarization to open back up.<ref name=":6" /> At potassium concentrations beyond 14mEq/L, enough sodium channels remain inactivated to no longer generate an action potential, ultimately leading to no heart beat.<ref name=":6" /> Heart potassium levels after lethal injection can reach 160.0 mEq/L.<ref>{{Cite journal |last1=Bertol |first1=Elisabetta |last2=Politi |first2=Lucia |last3=Mari |first3=Francesco |date=January 2012 |title=Death by potassium chloride intravenous injection: evaluation of analytical detectability |url=https://pubmed.ncbi.nlm.nih.gov/21923800/ |journal=Journal of Forensic Sciences |volume=57 |issue=1 |pages=273–275 |doi=10.1111/j.1556-4029.2011.01907.x |issn=1556-4029 |pmid=21923800}}</ref>
Depolarizing the muscle cell inhibits its ability to fire by reducing the available number of sodium channels (they are placed in an inactivated state). [[ECG]] changes
====Sodium thiopental====
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===New lethal injection protocols===
The [[Ohio]] protocol, developed after the incomplete execution of [[Romell Broom]], aims to ensure the rapid and painless onset of [[anesthesia]] by only using [[sodium thiopental]] and eliminating the use of Pavulon and potassium as the second and third drugs, respectively. It also provides for a secondary [[fail-safe]] measure using intramuscular injection of midazolam,
* Primary: Sodium thiopental, 5 grams, intravenous
* Secondary: [[Midazolam]], 10 mg, intramuscular, [[
In the brief for the U.S. courts written by accessories, the State of Ohio implies that they were unable to find any physicians willing to participate in development of protocols for executions by lethal injection, as this would be a violation of medical ethics, such as the [[Declaration of Geneva|Geneva Promise]], and such physicians would be thrown out of the medical community and [[shunning|shunned]] for engaging in such deeds, even if they could not lawfully be stripped of their license.<ref name="New Ohio Poisoning Protocol"/>
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On December 8, 2009, [[Kenneth Biros]] became the first person executed using Ohio's new single-drug execution protocol. He was pronounced dead at 11:47 am EST, 10 minutes after receiving the injection. On September 10, 2010, [[Washington (state)|Washington]] became the second state to use the single-drug Ohio protocol with the execution of [[Uttecht v. Brown|Cal Coburn Brown]], who was proclaimed dead within two minutes after receiving the single-drug injection of sodium thiopental.<ref>{{cite news |url=http://www.khq.com/Global/story.asp?S=13130297 |title=Cal Coburn Brown: Dead By Lethal Injection at 12:56 a.m. |date=September 10, 2010 |location=Walla Walla, Washington |publisher=KHQ |url-status=dead |archive-url=https://web.archive.org/web/20120112195615/http://www.khq.com/Global/story.asp?S=13130297 |archive-date=January 12, 2012 |df=mdy-all |access-date=December 16, 2018 }}</ref> Seven states ([[Arizona]], [[Georgia (U.S. state)|Georgia]], [[Idaho]], [[Missouri]], Ohio, [[South Dakota]], and [[Texas]]) have used the single-drug execution protocol. The state of Washington used this single drug method, but stopped when execution was abolished. Five additional states ([[Arkansas]], [[Kentucky]], [[Louisiana]], [[North Carolina]], and [[Tennessee]]) announced that they would switch to a single-drug protocol but, as of April 2014, had not executed anyone since switching protocols.<ref name="state-lethal-injection">{{cite web |url=http://www.deathpenaltyinfo.org/state-lethal-injection |title=State by State Lethal Injection |publisher=Death Penalty Information Center |access-date=April 25, 2014 |url-status=dead |archive-url=https://web.archive.org/web/20150403093930/http://www.deathpenaltyinfo.org/state-lethal-injection |archive-date=April 3, 2015 |df=mdy-all }}</ref>
After sodium thiopental began being used in executions, [[Hospira]], the only American company that made the drug, stopped manufacturing it due to its use in executions.<ref>{{cite journal |url=http://www.nature.com/news/2011/110127/full/news.2011.53.html |title=Death-row drug dilemma
==Euthanasia protocol==
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Typically, most states do not require that physicians administer the drugs for lethal injection, but most states do require doctors, nurses or paramedics to prepare the substances before their application and to attest the inmate's death after it.<ref name=":2" />
Some states specifically detail that participation in a lethal injection is not to be considered practicing medicine. For example, Delaware law reads "the administration of the required lethal substance or substances required by this section shall not be construed to be the practice of medicine and any pharmacist or pharmaceutical supplier is authorized to dispense drugs to the Commissioner or the Commissioner's designee, without prescription, for carrying out the provisions of this section, notwithstanding any other provision of law" (excerpt from Title 11, Chapter 42, § 4209).<ref name=delaware>{{citation |title=Delaware Code, Title 11, Section 4209 – Punishment, procedure for determining punishment, review of punishment and method of punishment for first-degree murder |publisher=LawServer Online, Inc. |url=http://www.lawserver.com/law/state/delaware/de-code/delaware_code_title_11_4209 |url-status=dead |archive-url=https://web.archive.org/web/20140423165628/http://www.lawserver.com/law/state/delaware/de-code/delaware_code_title_11_4209 |archive-date=April 23, 2014 |df=mdy-all |access-date=November 29, 2012 }}</ref> State law allows for the dispensing of the drugs/chemicals for lethal injection to the state's department of corrections without a prescription.<ref name=delaware/> However, states are still subject to [[DEA]] regulation with respect to lethal injection drugs.<ref>{{cite web |author=Admin |url=http://www.legalnews.com/detroit/1020375 |title=Arkansas State is latest to turn over execution drug DEA has seized drug supplies in Georgia, Kentucky and Tennessee > Detroit Legal News |publisher=Legalnews.com |date=2011-07-25 |accessdate=2022-02-26 |archive-date=September 12, 2015 |archive-url=https://web.archive.org/web/20150912235144/http://www.legalnews.com/detroit/1020375 |url-status=dead }}</ref><ref>{{cite web|url=https://www.ketv.com/article/dea-fda-continue-to-block-state-s-effort-to-get-lethal-injection-drugs/7656552#|title=DEA, FDA continue to block state's effort to get lethal injection drugs|date=November 28, 2015}}</ref>
==Controversy==
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Thiopental has a half-life around 11.5 hours (but the action of a single dose is terminated within a few minutes by redistribution of the drug from the brain to peripheral tissues) and the long-acting barbiturate phenobarbital has a half-life around 4–5 days. In contrast, the inhaled anesthetics have extremely short half-lives and allow the patient to wake up rapidly and predictably after surgery.
The average time to death once a lethal-injection protocol has been started is about 7–11 minutes.<ref>{{cite news |url=https://
====Dilution effect====
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{{more citations needed section|date=March 2017}}
Terminally ill patients in Oregon who have requested physician-assisted suicide have received lethal doses of barbiturates. The protocol has been highly effective in producing a so
Barbiturate overdoses typically cause death by depression of the respiratory center, but the effect is variable.<ref>{{Citation |last1=Kang |first1=Michael |title=Benzodiazepine Toxicity |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK482238/ |work=StatPearls |access-date=2023-06-14 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29489152 |last2=Galuska |first2=Michael A. |last3=Ghassemzadeh |first3=Sassan}}</ref> Some patients may have complete cessation of respiratory drive, whereas others may only have depression of respiratory function.<ref>{{Citation |last1=Drechsler |first1=Michael |title=Carbon Dioxide Narcosis |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK551620/ |work=StatPearls |access-date=2023-06-14 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=31869084 |last2=Morris |first2=Jason}}</ref> In addition, cardiac activity can last for a long time after cessation of respiration. Since death is pronounced after asystole and given that the expectation is for a rapid death in lethal injection, multiple drugs are required, specifically potassium chloride to stop the heart. In fact, in the case of [[Clarence Ray Allen]], a second dose of potassium chloride was required to attain.
===Stockpiling and sourcing of drugs===
A 2017 study found that four U.S. states that allow capital punishment are stockpiling lethal-injection drugs that are in short supply and may be needed for life-saving medical procedures elsewhere.<ref name="guardian-20apr2017">{{cite news|last1=Pilkington|first1=Ed|title=States are stockpiling lethal injection drugs which may be needed elsewhere to save lives|url=https://www.theguardian.com/world/2017/apr/20/states-stockpiling-lethal-injection-drugs-arkansas-execution|access-date=April 20, 2017|newspaper=[[The Guardian]]|date=April 20, 2017|url-status=live|archive-url=https://web.archive.org/web/20170420155309/https://www.theguardian.com/world/2017/apr/20/states-stockpiling-lethal-injection-drugs-arkansas-execution|archive-date=April 20, 2017|df=mdy-all}}</ref>
This stockpiling of lethal-injection drugs also extends to the federal level, with the source of such drugs being put into question. At least one alleged supplier, [[Absolute Standards]], is neither registered with the FDA,<ref>{{Cite news |last=Horton |first=Adrian |date=2024-04-08 |title=John Oliver on lethal injections: 'A protracted nightmare of suffering' |url=https://www.theguardian.com/tv-and-radio/2024/apr/08/john-oliver-lethal-injections-death-penalty |access-date=2024-04-12 |work=The Guardian |language=en-GB |issn=0261-3077}}</ref> nor registered as a controlled substances manufacturer with the DEA,<ref>{{Cite news |last=Allen |first=Jonathan |date=2020-07-14 |title=U.S. lawmakers ask four companies about role in government's execution drugs |url=https://www.reuters.com/article/idUSKCN24F2NY/ |work=Reuters}}</ref> and has seen investigations over its alleged involvement.
==See also==
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